ABSTRACT
As analysts and therapists nearly all of us have treated patients who have surprised or puzzled us in their response to treatment, some who in spite of favorable history and disposition have not made use of the treatment to change or improve and others who have unexpectedly done very well. These occasions cause us to search for explanations. Often, we conclude that there were dynamic factors that we did not recognize or that there was something constitutional in the patient that was responsible. Possibilities for overlooked dynamic factors are many, particularly as one becomes willing to entertain the many different perspectives and theories within psychoanalysis. In contrast, constitutional factors are usually conceptually vague and elusive or narrowly focused on organic dysfunction; furthermore, constitutional explanations may be invoked out of ignorance or avoidance of the psychodynamics. For these reasons, we may feel that explanations based on psychodynamic factors are superior.
